Vestibular neuronitis in a child with coronavirus disease 2019 infection and review of the literature.

OBJECTIVE: This article presents the case of an adolescent with asymptomatic coronavirus disease 2019 infection who had vestibular neuronitis symptoms. METHOD AND RESULTS: The new coronavirus disease 2019 demonstrates neurotropic properties, apart from airway symptoms. Early in the pandemic, coronavirus disease 2019 infection had been associated with olfactory disturbances. Accumulative evidence supports that both the infection with coronavirus disease 2019 and the vaccination against the virus may induce a condition of vestibular hypofunction, known as vestibular neuronitis. Coronavirus disease 2019 may directly affect the vestibular organs and ganglia, or indirectly damage them via immune-mediated mechanisms. In most cases, complete recovery is achieved with the typical therapeutic approaches for vestibular neuronitis, consisting of supportive measures and corticosteroids. CONCLUSION: Physicians may expect an increased incidence of vestibular neuronitis during the coronavirus disease 2019 pandemic. Conversely, coronavirus disease 2019 infection should be considered in patients with sudden vestibular symptoms.

Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study.

INTRODUCTION: Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty. PATIENTS AND METHODS: The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection. RESULTS: Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2. DISCUSSION: The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.

Clinicopathologic idiosyncrasies of nasopharyngeal cancer in a moderate-risk Mediterranean region.

Cancer of the nasopharynx displays an unparalleled skewness of its epidemiologic, pathogenic and clinico-prognostic characteristics depending on the geographic location. Between the endemic and sporadic forms, which occur in Southeastern Asia and Northern America, respectively, intermediate incidence is noted around the Mediterranean. This study describes the patterns of the disease affecting the population of Western Greece. The records of 70 patients with nasopharyngeal cancer diagnosed in a single institution between 1994-2014 were retrospectively reviewed. Primary treatment involved irradiation with or without concurrent chemotherapy. Demographic data, patient risk factors, tumour parameters, clinical presentation and treatment outcomes were assessed for potential intercorrelations. Overall (OS) and disease-specific (DSS) 5-year survival rates were determined. Possible predictors of survival were tested on univariate and multivariate analysis. WHO-type 3 histopathology was diagnosed predominantly (74.3%) and associated significantly with nasal symptomatology upon presentation (p = 0.050), metastatic lymphadenopathy (p = 0.028), advanced clinical stage (p = 0.009) and complete response to initial treatment (p = 0.018). Univariate analysis revealed a negative prognostic significance for older age (OS, p = 0.029 DSS, p = 0.041), poor response to treatment (OS & DSS p < 0.001) and cancer recurrence (OS, p = 0.003 DSS, p = 0.001). On multivariate analysis, disease relapse maintained its adverse effect (HR 7.442, 95% CI 2.199-25.187, p = 0.001). In conclusion, among nasopharyngeal carcinomas arising in western Greece, lymphoepitheliomas manifest a distinct clinical behaviour, so that their latest grouping along with WHO-type 2 tumours into the "non-keratinising" category may not apply. Regardless of pathology, cancer recurrence after initial remission is a severe event.

Intra-operative sclerotherapy for treatment of a head and neck venous malformation.

Venous malformations of the head and neck are congenital lesions that grow steadily without spontaneous regression. We describe the management of a 47-year-old woman with an extensive subcutaneous venous malformation of bilateral submandibular regions and the entire tongue, refractory to multiple surgical excisions and percutaneous sclerotherapy sessions. The tumour lacked prominent feeding arteries for embolisation, but maintained high blood outflow via a few substantial venous branches. Sclerotherapy to the lesion was prevented by major communicating branches from the mass to the internal jugular vein bilaterally. Our approach entailed direct surgical access to the malformation, ligation of these communicating veins and intraoperative sclerotherapy with ethanol injection into the vessel stumps.

Negative prognostic factors for head and neck cancer in the young.

PURPOSE: To evaluate the prognosis of head and neck (HN) squamous cell carcinoma (SCC) diagnosed in young people (≤40 years), and to compare it with the typical older patients. METHODS: The study population comprised 69 HN cancer patients below the age of 40 years. An equal-sized control group of older patients was pair-matched with the young cases. Cases and controls were compared for type and frequency of recurrence, in addition to survival. Tongue tumor specimens from 12 women of the study group (6 young and 6 old) were included in a pilot immunohistochemical analysis of estrogen receptors (ER) expression. RESULTS: Young patients with early (T1,T2) tongue cancer had shorter overall survival (OS) than their matched controls, but the finding was marginally non-significant (p=0.056). In the young population, late neck metastasis was a particularly aggravating factor for survival (p=0.004). In the case of tongue SCCs, young women were at the greatest risk of recurrence than any other gender-age combination (p=0.006). However, only 8.3% of tumors expressed ER. CONCLUSION: Early-stage tongue cancer, regional recurrence, and tongue SCCs in women are negative prognostic factors for young HN cancer patients. Treatment modifications targeting these subgroups might be beneficial.

Differential expression and cross-talk of peroxisome proliferator-activated receptor γ and retinoid-X receptor α in urothelial carcinomas of the bladder.

PURPOSE: the peroxisome proliferator-activated receptor γ (PPARγ), known to play a key role in homeostatic biological pathways, is also implicated in the process of carcinogenesis. Ligands for PPARγ and its heterodimeric partner, retinoid-X receptor (RXR), have exhibited anticancer effects both in vitro and in vivo. Unexpectedly, some studies suggested that PPARγ ligands may stimulate cancer formation. This study aimed to estimate the signaling of PPARγ-RXRα heterodimer in bladder urothelial carcinomas (BUC). METHODS: we studied PPARγ and RXRα expression in specimens obtained from 97 patients with BUC of various grades and stages using immunohistochemistry. RESULTS: PPARγ expression was significantly downregulated with BUC stage and grade progression, and the dynamics of this phenomenon was significantly influenced by RXRα's level of expression. CONCLUSION: the positive association of PPARγ expression in BUC with more differentiated, non-invasive tumors is strengthened by the presence of RXRα. This knowledge could probably be of use in the development of new chemotherapeutic agents.